{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T22:07:14Z","timestamp":1769551634830,"version":"3.49.0"},"reference-count":42,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,4]],"date-time":"2024-08-04T00:00:00Z","timestamp":1722729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite nationally endorsed treatment guidelines and stewardship programs, variation and deviation from evidence\u2010based antibiotic prescribing occur, contributing to inappropriate use and medication\u2010related adverse events. Measures of antibiotic prescribing variability can aid in quantifying this problem but are not adequate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study is to develop a standardized metric to quantify antibiotic prescribing variability (diversity) within and across children's hospitals, and to examine its association with outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a cross\u2010sectional study of empiric antibiotic exposure among children hospitalized during 2017\u20132019 with one of 15 common pediatric infections using the Pediatric Health Information System database. Encounters for children with complex chronic conditions, transfers in, and birth hospitalizations were excluded. Using the Shannon\u2013Weiner entropy index, we quantified antibiotic diversity for each infection type using the <jats:sc>d<\/jats:sc>\u2010measure of diversity. Generalized linear mixed\u2010effects models were used to examine the association between hospital\u2010level antibiotic diversity and risk\u2010adjusted length of stay and costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 79,515 hospitalizations for common pediatric infections were included. Antibiotic diversity varied within and across hospitals. Infections with low mean antibiotic diversity included appendicitis (mean diversity [mDiv]\u2009=\u20094.9, SD\u2009=\u20092.5) and deep neck space infections (mDiv\u2009=\u20095.9, SD\u2009=\u20091.9). Infections with high mean antibiotic diversity included pneumonia (mDiv\u2009=\u200923.4, SD\u2009=\u20095.6) and septicemia\/bacteremia (mDiv\u2009=\u200928.5, SD\u2009=\u200912.1). There was no statistically significant association between hospital\u2010level antibiotic diversity and risk\u2010adjusted LOS or costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We developed and applied a novel metric to quantify diversity in antibiotic prescribing that permits comparisons across hospitals and can be leveraged to identify high\u2010priority areas for local and national stewardship interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.13470","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T00:58:40Z","timestamp":1722819520000},"page":"8-16","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antibiotic Diversity Index: A novel metric to assess antibiotic variation among hospitalized children"],"prefix":"10.1002","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1616-7721","authenticated-orcid":false,"given":"Jessica L.","family":"Markham","sequence":"first","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City, University of Missouri\u2010Kansas City School of Medicine Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-5887","authenticated-orcid":false,"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City, University of Missouri\u2010Kansas City School of Medicine Kansas City Missouri USA"},{"name":"Children's Hospital Association Lenexa Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7902-7000","authenticated-orcid":false,"given":"Samir S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alaina","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Children's Mercy Kansas City, University of Missouri\u2010Kansas City School of Pharmacy Kansas City Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6628-8949","authenticated-orcid":false,"given":"Jennifer L.","family":"Goldman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children's Mercy Kansas City, University of Missouri\u2010Kansas City School of Medicine Kansas City Missouri USA"},{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"e_1_2_8_3_1","unstructured":"CDC.\u00a0Antibiotic use in hospitals.2017. 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